Profiles of women presenting for abortions in Singapore at the National University Hospital: focus on married women

INTRODUCTION@#In this study, we aimed to identify the differences in sociodemographic variables and reasons for termination of pregnancy (TOP) between married women and single/divorced women. We hope that this study can guide future policies and interventions to reduce the incidence of unsupported pregnancies in this profile group of women.@*METHODS@#We retrospectively evaluated the sociodemographic data of 802 women who underwent an abortion for social reasons at our institution in Singapore from January 2016 to September 2018. We compared the sociodemographic variables, reasons for and methods of TOP between married and single/divorced women.@*RESULTS@#We analysed data from 524 married women (65.3%) and 278 single/divorced women (34.7%). Married women were more likely to be of older age (29.5 years vs. 24.5 years, P < 0.001), had more living children and higher educational qualifications. The top two cited reason for abortions among married women were having enough children (42.0%) and the inability to afford another child (18.7%). Multivariate analysis showed that women aged >19 years and having more living children were independently associated with recurrent TOPs. Having a tertiary education was noted to be associated with less recurrent TOPs.@*CONCLUSION@#The most common reasons married women cited for having TOP include having enough children and the lack of financial capacity to afford another child. Recommendations to support women ought to be personalised and comprehensive in addressing their needs rather than offering a standardised support method. Greater emphasis should be placed on post-TOP family planning counselling to reduce repeated TOP.

Knowledge and factors determining choice of contraception among Singaporean women

<p><b>INTRODUCTION</b>The study aimed to assess the level of awareness and knowledge of contraception among women in Singapore, and identify the factors that influence contraception choice.</p><p><b>METHODS</b>We conducted a cross-sectional survey of 259 female patients, aged 21-49 years, who attended the Obstetrics and Gynaecology Clinic at National University Hospital, Singapore. An original questionnaire on nine contraceptive methods was used. Respondents who had ≥ 2 correct answers for a method (out of four questions) were considered to have good knowledge of the method. Participants were asked to rate factors known to influence contraceptive choice as important or not important.</p><p><b>RESULTS</b>Awareness of the following methods was high: condom (100.0%), oral contraception pill (89.2%), tubal ligation (73.0%) and copper intrauterine device (IUD) (72.2%). The women were least aware of hormonal IUD (24.3%). Women who were parous, had a previous abortion, had completed their family or used contraception previously were more likely to have a higher awareness of contraception. 89.2% of the women had good knowledge of the condom; among those aware of hormonal IUD, only 46.0% had good knowledge of it. Women who had used hormonal IUD and the condom were more likely to have good knowledge of them. Many rated efficacy (90.5%) and a healthcare professional's advice (90.1%) as important in contraceptive choice. Few considered peer influence (21.0%) and cultural practices (16.3%) to be important.</p><p><b>CONCLUSION</b>Women in Singapore have poor awareness and knowledge of contraception, especially long-acting reversible methods. More effective ways are needed to educate women about contraceptive methods.</p>

To establish the reference range of glycated hemoglobin.

Background: Diabetes mellitus (DM) has emerged as a major healthcare problem in India. There were an estimated 40 million persons with DM in India in 2007 and this number is predicted to rise to almost 70 million by 2025. It is estimated that every fifth person with diabetes will be an Indian. The objective of the present investigation was to establish the reference range for glycated hemoglobin (HbA1C) in healthy non-diabetic subjects in our hospital laboratory and compare it with the values reported by standard laboratories. Methods: The study was conducted in the Department of Biochemistry, MMIMSR, Mullana (Ambala, Haryana). Total number of subjects was 50 (25 males, 25 females), aged 30 to 70 years. 2 ml of blood was collected from antecubital vein under aseptic conditions from each subject and put in EDTA vials. Hemolysed blood was estimated by semiautoanalyzer for HbA1C. Results: In females, the levels were 6.50 ± 0.74 % while in males the levels were 6.27 ± 0.94 %. The overall range in females was 4.8 - 7.56 % while in males it was 4.2 to 7.56 %. The values were comparable (p>0.05) with those reported by standard laboratories, e.g. Dr. Lal PathLabs (<6%), Charak diagnostic (4.5-6.3%) and Mayo Clinic (6.5-7%). Conclusion: Our laboratory levels of HbA1C are comparable with the reference range of different laboratories and hence suitable to be used as cut-offs while interpreting the results of patients with DM.

Duxorubicin-induced cardiotoxicity.

The survival rate of cancer patients has greatly increased over the last 20 years. However, to achieve this result, a considerable price has been paid in terms of the side-effects associated with the intensive anticancer treatment. Cardiotoxicity of anticancer drugs is a serious problem. It is defined, by the National Cancer Institute, as the “toxicity that affects the heart.” This definition not only includes a direct effect of the drug on the heart, but also an indirect effect due to enhancement of hemodynamic flow alterations or due to thrombotic events. Cardiotoxicity can develop in a subacute, acute, or chronic manner. The risk for such effects depends upon: cumulative dose, rate of drug administration, mediastinal radiation, advanced age, younger age, female gender, pre-existing heart disease and hypertension. Anthracyclines, such as doxorubicin (DOX), cause serious cardiac side-effects. Acute tachyarrhythmias and acute heart failure (HF) may occur after high doses, but these reactions are now rare due to changed dosage schemes (e.g. slower infusion) with the aim to prevent this. However, the sub-acute or chronic cardiac effects of anthracyclines remain a clinical problem. Clinically, anthracycline induced cardiotoxicity manifests itself as left ventricular failure, which develops insidiously over months to years after completion of the anthracycline based chemotherapy and may result in congestive HF. The mechanism of anthracyclin induced cardiotoxicity is not totally unraveled. It is likely that the decline in myocardial function is related to apoptosis of cardiac myocytes that occurs apparently at random in the myocardium. Anthracyclin induced formation of reactive oxygen species (ROS) in the presence of intracellular iron, impaired homeostasis of intracellular iron and calcium (that may facilitate the apoptosis induced by the ROS) have been put forward as mechanisms. Cardiac protection can be achieved by limitation of the cumulative dose. Further, addition of the antioxidant and iron chelator dexrazoxane to anthracycline therapy has shown to be effective in lowering the incidence of anthracycline induced cardiotoxicity.

Serum Magnesium Levels: A Key Issue For Diabetes Mellitus.

The global burden of diabetes mellitus is expected to increase by 42% (from 51 million in year 1995 to 72 million by 2025) and by 172% (from 84 to 288 million) in the developed countries. The disease leads to many complications and one of them is electrolyte imbalance which has been an ignored subject. Amongst the electrolytes, magnesium merits special attention. The aim of the present study was to assess serum magnesium levels in Type 2 diabetics. A hospital based cross- sectional study was performed on 50 diabetic patients attending the OPD of medicine department from January 2011 to July 2011, M.M. Institute of Medical Sciences and Research, Mullana (Ambala). Thirty age-matched healthy controls were also selected for the sake of comparison. Blood was withdrawn and serum magnesium levels were estimated by colorimetric method using Xylidyl blue dye. The results were analyzed using Student's unpaired 't'test. Serum magnesium levels among normal healthy controls (n=30) ranged between 1.8-3.0 mg /dl (mean ±SD = 2.33±0.37 mg/dl), while the levels of serum magnesium in diabetic patients (n=50) ranged between 0.2-2.25 mg/dl (mean ±SD = 1.62±0.47). The difference was statistically significant (p<0.001). Levels of serum magnesium were significantly lower in diabetic patients as compared to normal healthy controls. Therefore, hypomagnesaemia is a key issue in diabetes which, if corrected, is expected to result in a better management of the disease.

Prevalence of ixodid ticks in Nilgiri district of Tamil Nadu state (India).

The Nilgiri hills provides favourable ecological conditions for the propagation of haematophagous arthropods due to its richness in vegetation and animal fauna. A study was undertaken by the NICD during August to November 1996 on the prevalence of ectoparasitic ticks from different localities of the Nilgiris district of Tamil Nadu state. The ticks were hand picked from various domestic animals of the study area and identified. A total of 1232 adults and immatures of ticks were collected from domestic animals which comprised of the various species in the order of abundance Boophilus microplus, Haemaphysalis bispinosa, Riphicephalus haemaphysaloides and Riphicephalus sanguineus. Studies carried out in the grass lands, meadows and areas adjoining to tea plantations by flagging method revealed mainly immature stages and few adults of Riphicephalus Spp. and Haemaphysalis Spp. The public health importance of the above species have been discussed.

Feeding pattern of anopheline and culicine mosquitoes in relation to biotopes and seasons in Delhi and environs.

In the studies to know the feeding pattern of various species of mosquitoes, a total of 7461 specimens comprising of Anopheles culicifacies (150), An. stephensi (61), An. subpictus (990), An. annularis (572), Culex quinquefasciatus (5217) and C. vishnui group (471) of mosquitoes were collected from different biotopes of selected localities in Delhi and environs during all the months of the year. The mosquito blood samples were processed by Gel diffusion technique to know the source of blood meal. Results of study revealed that the mosquito species tested in the study were by and large zoophilic and opportunistic feeders. The feeding behaviour was found to be highly influenced by biotopes from where the mosquitoes were collected, village and areas, different climatic seasons, sleeping behaviour of human beings and availability of alternative hosts particularly animal population. Overall anthropophilic index was found to be 24.66% for An. culicifacies, 20.96% for An. stephensi, 16.93% for An. subpictus, 9.96% for An. annularis, 26.33% for C. quinquefasciatus and 36.39% for C. vishnui group of mosquitoes. Feeding behaviour towards other animals viz: bovine, goat, dog, pig and bird for all these mosquito species in different months and biotopes e.g. human dwellings, cattle sheds and mixed dwellings; in different months and seasons of the year have been presented.